Originally published as JCO Early Release 10.1200/JCO.2007.13.5244 on October 27 2008

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Horan, J. T. Articles by Woods, W. G. Search for Related Content PubMed PubMed Citation Articles by Horan, J. T. Articles by Woods, W. G. Social Bookmarking                            What's this?

Impact of Disease Risk on Efficacy of Matched Related Bone Marrow Transplantation for Pediatric Acute Myeloid Leukemia: The Children's Oncology Group

John T. Horan, Todd A. Alonzo, Gary H. Lyman, Robert B. Gerbing, Beverly J. Lange, Yaddanapudi Ravindranath, David Becton, Franklin O. Smith, William G. Woods

From the Aflac Cancer Center and Blood Disorder Service, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; the University of Southern California Keck School of Medicine, Los Angeles; the Children's Oncology Group, Arcadia, CA; Department of Medicine, Duke University Medical Center, Durham, NC; the Children's Hospital of Philadelphia, Philadelphia, PA; the Children's Hospital of Michigan, Detroit, MI; the University of Arkansas for Medical Sciences, Little Rock, AK; and the Cincinnati Children's Hospital Medical Center, Cincinnati, OH

Corresponding author: John T. Horan, MD, Emory University, 1405 Clifton Rd, 3rd Floor, Atlanta, GA 30332; e-mail: john.horan{at}choa.org

Purpose There is considerable variation in the use of HLA-matched related bone marrow transplantation (BMT) for the treatment of pediatric patients with newly diagnosed acute myeloid leukemia (AML). Some oncologists have argued that BMT should be offered to most patients in first complete remission (CR). Others have maintained that transplantation in first remission should be reserved for patients with high-risk disease. We performed this study to determine how disease risk influences the efficacy of BMT.

Methods We combined data from four cooperative group clinical trials: Pediatric Oncology Group 8821, Children's Cancer Group (CCG) 2891, CCG 2961, and Medical Research Council 10. Using cytogenetics and the percentage of marrow blasts after the first course of chemotherapy, patients were stratified into favorable, intermediate, and poor-risk disease groups. Patients who could not be risk classified were analyzed separately. Outcomes for patients assigned to BMT and for patients assigned to chemotherapy alone were compared.

Results The data set included 1,373 pediatric patients with AML in first CR. In the intermediate-risk group, the estimated disease-free survival at 8 years for patients who did not undergo transplantation was 39% ± 5% (2 SE), whereas it was 58% ± 7% for BMT patients. The estimated overall survival for patients who did not undergo transplantation was 51% ± 5%, whereas it was 62% ± 7% for BMT patients. Both differences were significant (P < .01). There were no significant differences for survival in the other two risk groups or in the non–risk-stratified patients.

Conclusion Our study indicates that HLA-matched related BMT is an effective treatment for pediatric patients with intermediate-risk AML in first CR.

published online ahead of print at www.jco.org on October 27, 2008.

Supported by Children's Oncology Group (COG) Grant No. CA 98543. A complete listing of grant support for research conducted by Children's Cancer Group and the Pediatric Oncology Group before initiation of the COG grant in 2003 is available online at http://www.childrensoncologygroup.org/admin/grantinfo.htm.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				U. Creutzig, M. Zimmermann, G. Kaspers, and D. Reinhardt Postremission Management of Acute Myelogenous Leukemia in Children and Adolescents with and without Hematopoietic Stem Cell Transplantation in European and U.S. Study Groups ASCO Educational Book, January 1, 2009; 2009(1): 609 - 615. [Abstract] [Full Text] [PDF]